Your answer
(B) is not the one that we are looking for! (C) is correct!
- The clinical picture in this patient is most
consistent with critical aortic stenosis.
- Progressive stenotic valvular heart disease
should always be considered in the differential diagnosis of acute
left-sided heart failure.
- A bicuspid aortic valve is the most likely
etiology in the setting of the age and long standing murmur.
- The degree of stenosis may progress rapidly
in mildly symptomatic elderly patients with calcific disease
- Echocardiography is the initial diagnostic
study needed to confirm the clinical suspicion of critical AS.
- The soft murmur is due to the decreased
cardiac output.
- Younger patients may be operated upon in
some centers on the basis of the echocardiogram alone. Older patients
will need cardiac cath to define coronary artery anatomy.
- The LV function frequently improves following
prosthetic valve replacement if CAD is not present.
- The presence of a long standing murmur and LVH
on the ECG points to valvular rather than ischemic heart disease. Also,
there is no history or ECG findings to suggest an acute MI.
- The location, intensity and character of the
murmur are not suggestive of acute MR or VSD. Also, the LV on physical
exam lacks the hyperdynamic features of acute volume overload lesions
such as MR or VSD.
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